Gaining a New Perspective: Accommodations for those with FASD

 http://www.fascets.org/conceptualfoundation.html
FASCETS Conceptual Foundation: A Neurobehavioral Construct for Interventions For Children and Adults with Fetal Alcohol Spectrum Disorders (FASD)
 Fetal Alcohol Syndrome (FAS) has been referred to as the leading cause of mental retardation and developmental disabilities in the Western world for over fifteen years, a significant statement since underidentification of this population is still common. National and state studies have found that the numbers of women who drink during pregnancy continue to be high (CDC, 1997, Governor’s Task Force, MN, 1998, Oregon Benchmarks, 1998; the National Survey on Drug Use and Health found that although overall rates of use appear to be dropping, girls start using alcohol/drugs at higher rates than boys, 2006.)
The medical diagnostic criteria for FAS were established in 1973. Since then, thousands of research studies have explored the mechanisms of damage to fetuses caused by alcohol and other drugs. Increasingly sophisticated studies have clarified the nature and duration of these effects. It appears that of the drugs studied to date, e.g., cocaine and methamphetamine, prenatal exposure to alcohol causes the greatest damage to the developing brain and central nervous system.
People with Fetal Alcohol Syndrome, and particularly those with Fetal Alcohol Spectrum Disorders (FASD), are referred to as having an “invisible physical handicapping condition,” since there are few external physical characteristics of prenatal alcohol exposure. In these cases, the only symptoms of the underlying neurological disability are behaviors.
Although underdiagnosis of FASD is common, people with FASD are often assigned multiple DSM IV diagnoses, including Attention Deficit Disorder, Hyperactivity, Asperger’s Disorder, Learning Disorder, Reactive Attachment Disorder, Conduct Disorder, Emotionally Disturbed, Oppositional Defiant Disorder, and others.
Diagnoses on Axis I in the DSM IV organize constellations of presenting behaviors. Many capture primary neurobehavioral and secondary defensive behavioral symptoms of FASD. However, interventions generated on the basis of Axis I diagnoses address behavioral symptoms. The etiology of behaviors -- effects of brain dysfunction on behaviors -- is typically not recognized or incorporated into techniques. For example, recent research has found some medicinal and behavioral interventions for Attention Deficit Disorder (ADD) to be ineffective when applied to those with FASD/ ADD, since underlying neurocognitive characteristics of FASD and ADD appear to be significantly different (Coles, 1997).
Linking research findings with behaviors: A gap exists between the research on FASD, brain research, and behavioral literature. Historically, the idea of brain dysfunction, or the “organicity” concept, failed to gain general acceptance. This has been attributed in part to the complexity, subtlety and variability of effects and the overlap between neuro- and psycho-pathology. There is a vast body of medical literature on the physical characteristics of brain dysfunction, and an equally huge body of literature on behaviors. These two spheres have yet to merge.
Bridging this gap and linking the idea of brain dysfunction with behaviors creates an alternative explanatory theoretical framework that shifts thinking from learning theory into a neurobehavioral paradigm for understanding the meaning of behaviors. This paradigm redefines the meaning of behaviors and supports development of a more holistic and integrated method for systematically considering all facets of the person – physical, developmental, and cognitive. Linking brain dysfunction with behaviors is consistent with research on FASD. The resulting neurobehavioral construct is informed by research on FASD and is the basis for the FASCETS model. This model was developed on the basis of clinical work and research findings. It provides an organized approach for rethinking the meaning of behaviors, and generating specific, relevant techniques. This structure manages the complexity and diversity of neurobehavioral characteristics.
The challenge in creating this model has been to accurately translate research findings into practical information and training material that is intellectually accessible for a wide range of educational levels, and that has relevance for all disciplines.
The logic of interventions based on this model reads as follows: If children, adolescents and adults with FASD have by definition a physical disability – brain damage from prenatal exposure to alcohol/drugs -- and if the primary presenting symptoms of this disability are learning and other behavioral characteristics, then it follows that they would benefit from appropriate environmental accommodations. This is the same principle that is applied for people with more obvious physical handicapping conditions.
Presenting behavioral characteristics of people with observable physical challenges, e.g., paralysis, are different from behavioral characteristics associated with people with brain dysfunction, e.g., behavioral symptoms of sensory overload, memory problems, or dysmaturity. The obviousness of this statement is intentional: Behaviors that reflect underlying neuropathology are rarely framed in a neurological perspective and are instead viewed through a moral lens and seen as a function of volition, or psychopathology.
Although presenting behaviors indicating the presence of other physical disabilities are different, the principles for interventions for both kinds of physically-based conditions are the same. As self-evident as this seems, the application of this principle represents a nearly paradoxical way of thinking, understanding, and defining points of intervention.
People with physical challenges are provided with environmental accommodations, the range of which reflects the variability of disabling conditions. The more obvious the disability, the clearer the nature of the accommodations, e.g., where there is paralysis, wheelchairs and ramps are provided. When presenting symptoms of a disability are behavioral, identification of accommodations is more elusive, e.g., modifying timelines, providing alternative instructional strategies, or recognizing developmental rather than chronological age. However, just as outcomes are improved for others with recognized disabilities whose needs have been addressed, preliminary clinical findings of improved outcomes for children, families and professionals based on this approach suggest the efficacy of this model for those with FASD.
A question of fit: FASD as a social problem is emerging in a world still dominated by learning theory and a behavioral paradigm. This paradigm, with associated assumptions about brain function and behaviors, forms the basis for understanding and intervening in behavioral symptoms. These assumptions remain unexplored for their relevance for people with neurobehavioral disorders. FASD challenges the theory to expand to include the neurobehavioral dimension, since interventions based on the principles of learning theory are often incompatible with the needs and abilities of people with FASD.
The poor fit between behavioral techniques and FASD may be indicated by findings from the Secondary Disabilities study published by Dr. Streissguth (1996). For example, this study found mental health problems to be the most common secondary disability associated with FASD. Secondary disabilities are defined as defensive behavioral characteristics and are not intrinsic to FASD. These are challenging behaviors that develop over time as a function of a chronic poor fit between the person and his or her environment.
The most important finding of Dr. Streissguth’s study may be implicit. Following diagnosis for FAS and FAE, subjects continued to receive standard interventions, e.g., mental health and school services, and traditional parenting techniques. Most of these are cognitive-behavioral interventions based on learning theory and are variations on a theme of one: Identify problem behaviors and target these for change.
The research findings of high frequencies of secondary problems occurred in spite of these interventions. Rather than suggest the inevitability of deterioration and associated secondary challenging behavioral characteristics, these findings appear to indicate the ineffectiveness of otherwise good traditional, learning-theory based techniques.
Interventions that focus on changing presenting behaviors that are symptoms of a disability seem to yield frustration and behavioral deterioration. The net effect is like inadvertently “beating the blind child who refuses to read the blackboard.” Paradoxically, when behaviors are understood differently as cues, or symptoms, of an underlying disability and environments are adapted to provide a good fit with the needs and strengths of the individual, many challenging behaviors resolve. Including the key variable of brain dysfunction and understanding behaviors from a neurobehavioral perspective provides a way to shift from seeing the child as being the problem, to understanding the child as having a problem, a physical disability.
The apparent limits of the learning theory paradigm may contribute to the paucity of interventive research on FASD. There has long been speculation that few interventive studies on FASD exist. This was confirmed by researchers in Canada who searched the literature on FASD and published a State of the Evidence Review (Premji, 2004). Of 16,913 references, only seven interventive studies were located. One was the three-year FASD interventive study conducted by FASCETS and funded by the State of Oregon that tested this neurobehavioral approach for working with children and adolescents with FASD. The project was an educational, community-based, multisystem collaboration. The goal was to increase understanding of behaviors from a neurobehavioral perspective, and generate congruent accommodations across domains that create a good fit for children with FASD in all environments. The hypothesis was that behavioral improvements would be a function of adults understanding children differently and providing accommodations in all settings. Statistically significant findings of reduced secondary behavioral characteristics in children and improvements in parents and professionals suggest the potential viability of this construct (Malbin 2002).
Innovativeness: The definition of a problem determines the intervention, or, beliefs dictate interventions (Holloway, in lecture, 1989). If a behavior is viewed as a function of willfulness, or choice, interventions typically focus on changing the behavior. If a behavior is recognized as having a neurological basis, then the target for intervention includes the environment. Recognizing brain dysfunction as the etiology for behaviors redefines perceptions, which then redefines the nature of the problem and clearly redefines the nature of interventions.
The shift in focus is from the child to the child-in-the-environment, from trying harder using increasingly controlling and coercive measures, to trying differently and paradoxically achieving reductions in secondary behaviors through environmental accommodations. This is like writing the IEP for the environment.
The simple idea of reframing perceptions to see behaviors as symptoms, rather than as the thing to be changed, is new. The simplicity of the statement belies the intellectual shift this entails. Preliminary findings from the three-year study mentioned above that explored the soundness of this hypothesis clearly suggest that as caregivers and professionals understand behaviors differently, their perceptions change, options expand, and secondary symptoms in children are reduced.
The innovativeness of this model is found in its redefinition of problems and solutions in a manner consistent with research findings. The study based on this model tested an approach rather than a technique. Statistically significant findings of improvements suggest the importance of further research on this approach.
Implementation: Accommodations in all environments are provided for people with other physical disorders. Accordingly, accommodations in all systems of care are also necessary for people with FASD. An educated community-based multidisciplinary continuum of care facilitates sustained implementation of accommodations.
The process of implementation is enhanced by recognizing personal, historical, cultural, intellectual, institutional, and fiscal issues and associated with this issue. The complexity of these dynamics suggests the importance of a comprehensive and thoughtful approach, a reasonable timeline, and adequate support for achieving sustained multisystems implementation. Support for implementation required by this approach is decremental, meaning there is less need for external supports over time. This is an empowerment model in the best sense of the term, proactive rather than reactive. It supports youth and adults with FASD, parents, professionals and their systems.
Conclusion: The goals of this approach are to increase understanding of FASD as a primary brain-based physical disability with behavioral symptoms, to increase effectiveness and efficiency of practice and program design, and to contribute to the long range goals of community healing and prevention of FASD.
  http://www.fascets.org/conceptualfoundation.html

Understanding FASD

http://www.fascets.org/info.html

UNDERSTANDING FASD:

FASD is often termed an "invisible physical handicapping condition."  The effects of prenatal alcohol and other drug exposure on the developing brain are the most debilitating aspects of this condition. These effects are invisible. The only indicators of this physical disability are found in learning and other behavioral characteristics.

Parents and professionals often find standard techniques are ineffective. Many people experience increasing frustration over time when childrens' behaviors are unresponsive to traditional interventions. Until recently, there has been little information linking the "organicity," or neurological differences associated with FASD, with behaviors.

Information linking brain function with behaviors increases understanding, reduces frustration, and contributes to successful outcomes. Knowledge about FASD and organicity provides a way to shift perceptions: Children may be understood as having a problem rather than being the problem.     As a result, rethinking and reframing interpretations of behaviors contributes to developing effective and appropriate strategies, "trying differently rather than trying harder." Successful strategies support children, and contribute to the well-being of parents and professionals.

FASCETS supports the development of a family-centered, community-based, multidisciplinary continuum of care. This collaborative design has been found to be effective in enhancing communication among parents and professionals for their mutual benefit.

PRIMARY CHARACTERISTICS OF FASD;
The following neurodevelopmental characteristics are commonly associated with FASD. No one or two is necessarily diagnostically significant; many overlap characteristics of other diagnoses, e.g. ADD/ADHD, learning disabilities, and others. Typical primary characteristics in children, adolescents, and adults include:

• Memory problems
• Difficulty storing and retrieving information
• Inconsistent performance ("on" and "off") days
• Impulsivity, distractibility, disorganization
• Ability to repeat instructions, but inability to put them into action ("talk the talk but don't walk the walk")
• Difficulty with abstractions, such as math, money management, time concepts
• Cognitive processing deficits (may think more slowly)
• Slow auditory pace (may only understand every third word of normally paced conversation)
• Developmental lags (may act younger than chronological age)
• Inability to predict outcomes or understand consequences 

COMMON STRENGTHS:
 Many people with FASD have strengths which mask their cognitive challenges.

• Highly verbal
• Bright in some areas
• Artistic, musical, mechanical
• Athletic
• Friendly, outgoing, affectionate
• Determined, persistent
• Willing
• Helpful
• Generous
• Good with younger children 

POSSIBLE SECONDARY CHARACTERISTICS:
In the absence of identification, people with FASD often experience chronic frustration. Over time, patterns of defensive behaviors commonly develop. These characteristics are believed to be preventable with appropriate supports.

• Fatigue, tantrums
• Irritability, frustration, anger, aggression
• Fear, anxiety, avoidance, withdrawal
• Shut down, lying, running away
• Trouble at home, school, and community
• Legal trouble
• Drug / Alcohol abuse
• Mental health problems (depression, self injury, suicidal tendencies)

http://www.fascets.org/info.html

Intervention: Tackling the Room!

Today I forced myself to "tackle" my son's room.  Yes, it most definitely needed some attention. I felt there was just too much stuff in his room.  I kept putting off doing it 'cause I didn't know where I was going to put all the stuff, but I decided to leave that excuse in the hallway...literally...Now, all the stuff is in the hallway, waiting for a new home.
I've cleaned out and organized my son's room before, but this time was different.  This time I literally took everything out of his room and I ONLY PUT BACK WHAT I FELT WAS NECESSARY.

HERE'S WHAT STAYED:


HIS TIRE SWING STAYED.  A couple years ago we had an Occupational Therapist recommend we put a swing in his room, and so we did.  It has been a very good thing for my son and will definitely stay in his room.

THE MONKEY BARS are permanent and of course, stayed.  The Occupational Therapist also recommended we put monkey bars in his room, and gratefully, I have a very handy husband who had the monkey bars built and up and going in just a couple days.  The monkey bars have also been a very good thing.

STUFFED ANIMALS IN HIS CLOSET:  I completely emptied his closet and then decided to put only stuffed animals in his closet.  He has a lot of stuffed animals and they are all very important to him.  They fit perfectly on the shelves in his closet.  He doesn't have closet doors so it feels more like they are just on shelves in his room. 

HIS BED:  Because of the space the monkey bars and swing take up in his room, his bed is simply a mattress on the floor. The mattress fit nicely in front of the closet and that way his animals are all by him while he sleeps, just like he likes it.

ONE BOOKCASE (3 shelves):  I kept one bookcase in his room.  Top shelf:  a few legos, water bottles, lotion and hand sanitizers (Again, things that are important to him).  Middle shelf:  special things:  picture, special clay animals he made, puzzle star, etc.  Bottom shelf:  books.

BIG PILLOW/BEAN BAG:  I put a big pillow and bean bag by his book shelf so he can sit there and read if he wants.

HOOKS ON THE BACK OF HIS DOOR:  On the back of his door there are hooks.  On the top hooks I put his backpack, special bag, and water bottle carrier.  On the bottom hooks, I put his cub scout shirt and his jacket.

PLASTIC DRAWERS FOR CLOTHES: I put all his clothes in small plastic drawers.  Each drawer is labeled with "pants", "shirts", "socks", etc.  Everything has a place.  I lined his shoes up next to the plastic drawers.

AND THAT'S IT...THAT'S ALL THAT'S IN HIS ROOM.

THE RESULT:  Seeing how I did this without consulting with my son, I was a little nervous about his reaction, especially since all his toys, stuff, etc. were just in the hallway.  BUT he didn't even care about the toys he passed in the hallway.  HE LOVED HIS ROOM THE WAY I HAD ORGANIZED IT!  His face lit up when he walked in and he sat on his swing and whispered to himself:  "This is way better.  This is way better."  And it's not like his room was messy before...we kept it clean most of the time...but I just think it was TOO MUCH STUFF.  I think he will like it much better this way.  We will give it the "2 week try" and assess! Now I just have to find a place for his legos, blocks, toys etc...cause those are good for him too...but just not good in his room.


INTERVENTION:  THE POINT OF THIS INTERVENTION IS TO ASSESS THE ENVIRONMENT, PRIMARILY HIS ROOM, TO SEE IF IT IS TOO MUCH OR TOO OVERSTIMULATING....AND THEN CHANGE IT TO NOT BE OVERSTIMULATING.

Updated Afternoon Schedule

It has been 2 weeks since I began the intervention with the "Consistent Schedule of a Routine", posted on May 1st, 2013.  I have found that the morning and evening schedule has been helpful and made a difference the majority of the time.  I feel the afternoon schedule needs to be updated.  I sat down with my son and made a more specific afternoon schedule, and it is posted here:

Monday.:
1. Shower
2. Job:  Clean upstairs family room.
3. Wii
4. Read books

Tuesday:
1. Shower
2. Job:  Clean upstairs family room.
3. T.V.
4. Piano

Wednesday:
1. No Shower

2. Webelo Scouts
3. Clean and Vacuum upstairs family room
4. Free time choice

Thursday:
1. Shower
2. Job:  Clean upstairs family room.
3  Computer
4. Legos

Friday:
1. Shower
2. Job:  Clean upstairs family room.
3. Bike
4. Movie

Don't try harder, try differently!

As a general rule, when working with persons with an FASD, if a situation is not working, STOP, OBSERVE, and ASK CONCRETE QUESTIONS (not abstract questions).  "Why?" is a very abstract question and will not bring good results with a person with an FASD.  Good, concrete questions to ask are as follows:  "What was hard for you?"  "What would help?"  "What were you frustrated about?"
DON'T TRY HARDER, TRY DIFFERENTLY!
"If  a child is told 1,000 times and still doesn't understand, then it is not the child who is the slow learner." -Walter Barbee

8 essentials for success with FASD

1. CONCRETE
not abstract

2. CONSISTENCY
and be predictable

3. REPITITION
this is very helpful

4. ROUTINE
keep a strict schedule...even to the point of leaving early to keep the child's bedtime

5. SIMPLICITY
do not overstimulate

6. SPECIFIC
say exactly what you mean

7. STRUCTURE
this is the glue that helps the world make sense to persons with an FASD

8. SUPERVISION
keep the child with an FASD and others safe

-Deb Evensen and Jan Lutke 1997 "8 magic keys"

F.A.S.D. BASICS

Alcohol is a teratogen, which means it crosses the placenta barrier and causes damage to the brain.  The surgeon general says that there is NO AMOUNT OF SAFE ALCOHOL DURING PREGNANCY.  There are 3 reasons why woman may drink when they are pregnant:  1) addiction to drinking 2) she didn't know she was pregnant 3) mis-informed:  she didn't know that alcohol CAN cause harm to the unborn baby.
It is NOT SAFE to drink during ANY part of the pregnancy.  50,000 brain cells form each second during pregnancy.  Drinking alcohol in moderation is NOT SAFE.  Red wine is NOT SAFE.  Alcohol is alcohol and any form of alcohol can harm the unborn baby.  Four factors affect how the alcohol will affect the unborn baby:  1. Timing of exposure to alcohol (1st Trimester is most damaging, BUT remember, alcohol can be damaging in ALL trimesters) 2. Amount of alcohol (Binge drinking is more likely to cause more harm) 3. diet and metabolism of mother  4. resiliency of the fetus:  we each have a different resiliency (more likely to get sick, etc.)  Exposure to alcohol in pregnancy is going to affect each individual differently and in varying degrees.  However, this fact remains: alcohol can take potential away.

Alcohol exposure to the unborn baby can effect/damage the CORPUS CALLOSUM, which affects memory and communication.  It can also effect other areas of the brain.  It often greatly effects the FRONTAL LOBES, which affects impulsive behavior, decision making, judgement/problem solving, generalize learning, attention (being "tuned in"), understanding social cues.
Persons with an FASD may also struggle with attention deficit, hyperactivity, memory deficit, difficulty with abstract, inability to manage money, difficulty with the passage time, lack of control over emotions, and difficulty understanding cause and effect (consequences).

Examples of some of these behaviors: 
1)  Impulsive behaviors/Consequences:  A child with an FASD is continually stealing. (impulsive behavior)  The parent imposes consequences; however, the child continues to steal.  Finally, the parent imposes a harsher consequence:  "if you steal again, we will throw away your blanket" (a blanket that the child is greatly attached to and loves).  The child steals again, the blanket is thrown away; however, the child steals again the very next day.  Consequences do not help the child change behavior in the long term.  Short term consequences are more effective.  The same child is asked (after stealing), "Who do I need to give this back to?" and the child is told if he/she answers right away, there will be no consequence.  The child answers right away.  The difference here is that the consequence is immediate/short-term.  There is no set formula for how a child with an FASD will respond to consequences. The point is that it is difficult for persons with an FASD to understand cause and effect and consequences are typically ineffective in changing their behaviors.

2) Time and Money:  Typically, a person with an FASD can spend his/her paycheck immediately...and do not have a good concept of saving money and paying bills.  A person with an FASD will need an "external brain": someone to help him/her manage money and time.

3)  Generalizing:  A child with an FASD sees an ad for a free cel phone.  It is explained to the child that the little * by the "free cel phone" explains terms of use, which cost money.  The child understand what is said; however, the next day the child sees a new ad for a "free cel phone" and is unable to generalize that what was taught applies to all "free cel phones".

4)  Memory:  A mother works for hours with her child, practicing times tables. By the end of the practicing, the child is able to answer several answers correctly.  The very next day they work on the same times tables, and the child is unable to answer them correctly.  This is just one example of how memory can be affected.

FASD usually becomes more noticeable as the child reaches about the age of 4th grade.  In school, from Kindergarten to 2nd/3rd grade most of the skills learned are concrete.  At 3rd or 4th grade the curriculum becomes more abstract, and the child's social inadequacies are more noticeable by his/her peers.  In general, a person with an FASD's emotional age is about 1/2 of his/her chronological age.  So a 10 year old, appears to be about 5 years old emotionally, and this becomes more noticeable to peers as the child grows older.

FASD is an invisible, hidden disability because the child appears normal physically; however, the brain's ability to function has been impaired.  The person is expected to perform as a normal child would because he/she appears normal; however, the person with an FASD does not have the same brain capacity/ability to function as a normal child does.


--these are my notes/thoughts that I have written after listening to a webex given by Barb Clark, through the  MOFAS organization (mofas.org)

VERY HELPFUL LINK/RESOURCE for F.A.S.D. and F.A.S.

VERY HELPFUL LINK/RESOURCE:

http://www.come-over.to/FASCRC/
-by Teresa Kellerman

Resources

Resources:
While I'm not able to add a direct link to these websites yet, I still wanted to post these resources/websites for a reference:

SAMHSA FASD Center for Excellence: fasdcenter.samhsa.gov

Centers for Disease Control and Prevention FAS Prevention Team: www.cdc.gov/ncbddd/fas

National Institute on Alcohol Abuse and Alcoholism (NIAAA): www.niaaa.nih.gov/

National Organization on Fetal Alcohol Syndrome (NOFAS): www.nofas.org

NOFAS Resource Directory: www.nofas.org/resource/directory.aspx

National Clearinghouse for Alcohol and Drug Information (NCADI): ncadi.samhsa.gov

For more information about FASDs, including topics such as diagnosis and treatment, please visit http://www.fascenter.samhsa.gov.

Paradigm Shift

What is needed to adequately address FASDs is a paradigm shift in how we think:


“We must move from viewing the individual as failing if s/he does not do well in a program to viewing the program as not providing what the individual needs in order to succeed.”
—Dubovsky, 2000

Intervention: JUST GO WITH IT

When a person with an FASD wants something/wants to do something a certain way, go with it, IF it is not going to harm anyone and is giving you the outcome you want. Get in their world...quit trying to make them "fit" into yours.
Persons with an FASD have enough to deal with already...Go with what they want when you are able to...it makes for a happier journey.

FLEXIBILITY helps with this.
My husband told my son it was time to shower.  It was one of those days when my son did not want to shower.  My son finally said, "ok fine then, just buzz (cut) my hair and then I'll shower".  My husband said OK...he buzzed his hair and then my son showered.  
Just go with it....and....Be Flexible.

Intervention: consistent SCHEDULE of a ROUTINE and BE PREDICTABLE

The first intervention I'm putting in place is the consistent SCHEDULE OF A ROUTINE...going right along with this is to BE PREDICTABLE.  For example, I will give my son a 5 min. warning before something changes.  ie. "you have 5 min. left to do that activity, then it will be time to eat dinner"
I typed up 3 schedules for my son:  morning, afternoon, and bedtime.  I put spaces between each step so that it's not visually overstimulating.  They hang on the wall next to his light switch in his room.
*Items in colored writing are revisions:  things I added and/or changed as we tried this intervention.

MORNING:
1.  Make Bed.

2.  Say Prayers.

3.  Get Dressed.  Put shoes and socks by your lunchbox.
*On Sunday put shoes and socks by your scriptures*

4.  Eat Breakfast.

5.  Brush Teeth.

6.  Piano with mom.

7.  Book of Mormon story with mom.

8.  School work.

AFTERNOON (after school):
1.  Shower.

2.  Activity(s) (ask Mom)

3.  Take out Trash.

4.  Dinner.

5.  Sweep floor.

6.  Family Prayers.

UPDATED AFTERNOON SCHEDULE: (5/15/13)
Monday.:  
1. Shower
2. Job:  Clean upstairs family room.
3. Wii
4. Read books

Tuesday:
1. Shower
2. Job:  Clean upstairs family room.
3. T.V.
4. Piano

Wednesday:
1. No Shower
2. Webelo Scouts
3.  Clean and Vacuum upstairs family room
4.  Free choice

Thursday:
1. Shower
2. Job:  Clean upstairs family room.
3  Computer
4. Legos

Friday:
1. Shower
2. Job:  Clean upstairs family room.
3. Bike
4. Movie

BEDTIME:
1.  Put Pajamas on.

2.  Put Clothes Away.

3.  Lay out clothes, shoes, socks for next day.

4.  Brush Teeth.

5.  Say Prayers.

6.  Read Books.

7.  Turn lights out.

8.  Go to sleep.